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Focus on the Pipeline
In 2001, more than 25 state laws were enacted to address the nursing shortage. Two-thirds of these were designed to encourage more students to go into nursing programs.217 Similarly, in September 2001, Secretary of Health and Human Services Tommy Thompson announced a program to give $27.4 million worth of grants and contracts to institutions of higher education to increase the number of future RNs.218 "We have a severe nursing shortage in this country," Thompson warned, "and it's absolutely critical that we encourage more of our nation's students to choose careers in nursing. Secretary [of Education] Paige and I both want students to realize that nursing is an exciting and satisfying career that makes a difference in people's lives."219
While perhaps well-intentioned, these initiatives are misguided. First, the nursing shortage can most quickly be solved not by expanding the number of students in nursing programs but by improving working conditions so that existing but currently non-working RNs will choose to return to the profession. More to the point, producing more graduates of nursing schools will do little good if these nurses become disillusioned and drop out after a few years of hospital work. This, in fact, is exactly what the evidence suggests. Recently graduated RNs are no more satisfied with their jobs than are older nurses. The New Hampshire study, for example, found that nurses under 30 are not only the lowest paid but also the least likely to feel that they are being paid a fair wage.220 Similarly, the Nursing Executive Center reports that 31 percent of nurses under age 24 changed hospitals within the past two years, as did 20 percent of nurses aged 35–44.221
As long as the conditions on the job are not improved, expanding nursing schools amounts to little more than a bait-and-switch strategy, hoping that student nurses won't discover the downside of their profession until it's too late. Inevitably, however, even beginning nurses will start thinking about leaving once they realize the realities of their chosen occupation. "Nurses leave nursing after one year because it is so hard and too fast paced," explained one hospital's human resources director.222 Under these conditions, a strategy of expanding the pipeline is akin to pouring water into a bucket that has a gaping hole in its bottom and wondering why it never seems to fill up. As the American Hospital Association notes,
To solve the workforce crisis, individual hospitals need to recruit new employees into the organization. But the overall situation will not improve if employees leave organizations as fast as new workers are hired. Retention is just as important as recruitment. ... Even if enrollment in education programs for health professionals and support personnel increases, the hospital workforce shortage will not diminish if new graduates continue to rapidly leave the hospital setting.223
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